CARE HOMES FOR OLDER PEOPLE
Walton House Nursing Home Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD Lead Inspector
Mrs Marie Matthews Unannounced Inspection 22nd August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Walton House Nursing Home Address Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD 01772 628514 01772 697200 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Andrew`s Health Care Limited Mrs Jane Lyth Care Home 44 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (44), of places Terminally ill (3) Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. This home is registered for a maximum of 44 service users to include: Up to 44 service users in the category of OP (Old Age, not falling in any other category) Up to 3 service users in the category of TI (Terminally Ill). The service should at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 14th December 2005 5. Date of last inspection Brief Description of the Service: Walton House is a care home providing personal and nursing care for up to forty-four residents. The home is located in Walton-le-Dale, near to shops, pubs, a post-office and other town amenities. There is car parking at the main front entrance and a garden area with flowerbeds, patio areas and seating at the rear of the house. The home is a two storey purpose-built building with a passenger lift to access both floors. Bedroom accommodation is on the ground and first floors. The majority of bedrooms are single, however a number of companion rooms are available for those who wish to share. There are no en-suite bedrooms. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. There are lounge areas on each floor and the dining facilities are situated on the ground floor. Corridors are wide and fitted with grab rails. Other appropriate aids are provided to assist service users with mobility problems. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees from April 2006 range from £350.00 to £570.00. Additional charges are made for hairdressing, chiropody, personal toiletries and escort to appointments.
Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection was conducted at Walton House on 22nd August 2006. The inspection involved looking at records, talking to the registered manager, four staff, two visitors and four residents, a tour of the premises and generally looking at what was happening in the home. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There thirty-eight residents living in the home on the day of the inspection. What the service does well:
Staff were observed speaking in a friendly but respectful manner to residents and any visitors to the home. Visitors were happy with the care, said they were always welcomed into the home and that staff were friendly and showed them respect. Residents and relatives confirmed they were able to make choices about various aspects of their lives including routines, friendships, involvement, meals and activities. One resident said I never want for anything. The home had made sure that people had been involved in decisions about their care. Care plans had been reviewed regularly and residents and relatives had been invited to discuss their care with staff. Records and discussions with staff and residents showed that staff tried hard to meet people’s diverse needs. Care plans included detailed information, provided by residents or their relatives, about hobbies, interests, previous occupations and likes and dislikes and activities were provided to meet resident’s individual preferences. The home had their own transport that was used to take residents out on regular outings. One resident said ‘there is always something or other going on. Residents made positive comments about the food the meals are excellent and there is a choice you can have anything. A relative said that there was Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 6 always a choice from the menu or the cooks would always find something that suits you. Residents were protected by the homes adult abuse policies, procedures and by staff awareness. The home had a good complaints system and people were happy that their concerns would be listened to and responded to. Resident’s rooms and communal areas were bright and comfortable. Some residents had brought in personal items to make their rooms more homely. Residents said they were happy with their rooms. The outside of the home was well maintained and residents said they enjoyed the gardens. Garden furniture, flower tubs, bird tables, water features and chimes were provided for residents enjoyment. The home was equipped with aids and adaptations to assist staff to meet residents needs. The layout and design of the home was suitable for the people who lived there. The home was well staffed with a competent, appropriately trained team of staff who were able to meet the diverse needs of the residents. The home used thorough recruitment procedures to ensure residents were safe and protected from unsuitable people. The home consulted regularly with people and evidence showed that their views were both sought and acted upon. The home had good systems in place to look at the way the home was run and to make sure it was providing residents with the care they needed. The home was well managed and people were confident they would be properly looked after. One resident said ‘staff are grand’. A visitor said ‘everyone is looked after really well, the staff make sure of that’. What has improved since the last inspection?
Residents were admitted only when assessments had been completed and the home was clear their needs could be met. Care plans were organised and generally contained sufficient detail to ensure staff had information to help them to meet resident’s needs. The maintenance records showed that all areas of the home were checked every month and that rooms had been redecorated and refurbished. Residents said that redecoration and refurbishment was ongoing and this made sure the home was a bright, safe, comfortable and clean place to live. Records showed that the home provided a safe place to live and work in. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were admitted only when the home was clear their needs could be met. EVIDENCE: Two residents care plans were looked at. One resident, who had recently been admitted, had a detailed assessment done prior to admission to the home to make sure that the home could meet his needs. Another resident had an updated assessment on file and changes had been made to the care plan to reflect the care he needed. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans were generally detailed, reviewed regularly and showed that people were involved in choices and decisions about their care. The home generally managed medication safely but some areas needed to be improved to make sure that residents were not placed at risk. EVIDENCE: Two care plans were looked at. Care plans were organised and generally contained sufficient detail to ensure staff had information to help them to meet resident’s needs. Risks had been assessed although staff had not always included detail in the care plan about action to be taken by staff once a risk had been identified. Care plans had been reviewed regularly and relatives and residents had been involved in decisions about their care. There was evidence to support residents had access to healthcare and were provided with specialist equipment. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 11 The home had recently reviewed the medication system. Policies and procedures had been reviewed to reflect current practices. However some of the procedures were duplicated and offered different advice that may cause inappropriate guidance for staff. Records were clear and accurate. The home needed to develop clear protocols for PRN medication and avoid the use of ‘as directed’ instructions on medication charts and packaging. Residents should be able to take responsibility for their own medications if they wish, within a risk assessment framework and a procedure should be available to support this. Storage areas were clean and tidy. Oxygen was stored securely in the clinical room but not in resident’s rooms and could be a risk to residents, staff and visitors. Fridge temperatures were recorded but the home should also record the temperatures of medication storage areas. Care staff were monitoring blood sugar levels of residents. The manager was advised that this must only be undertaken by care staff following training by an appropriate practitioner followed by an assessment of competency and authorised by the district nurse responsible for that resident. This must also be kept under review. Staff were observed speaking in a friendly but respectful manner to residents and any visitors to the home. Training included issues around privacy and dignity. One visitor said she was always welcomed into the home and that staff are friendly and show respect. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The home met residents individual and diverse needs, expectations and preferences and helped them to maintain contact with friends and family. Residents were offered a choice of wholesome, varied and appealing diet. EVIDENCE: Residents and relatives confirmed they were able to make choices about various aspects of their lives including routines, friendships, involvement, meals and activities. One resident said I never want for anything. Care plans included detailed information, provided by residents or their relatives, about hobbies, interests, previous occupations and likes and dislikes. Records showed what activities or one to one sessions each resident had been involved in and a photo board showed various activities that had taken place. An activity co ordinator was employed to provide a range of suitable activities and entertainments, both inside and outside the home. Activities included pottery, flower planting, church visits, reminiscence therapy, glass painting, exercise, visits from local guides and children, shopping and one to one sessions. Records and discussions with staff and residents showed that staff tried hard to meet people’s diverse needs. A plan of activities for the week
Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 13 was seen and on the day a visiting singer was enjoyed. The activity coordinator said that activities were dependent on resident preferences, abilities and the weather. A minibus was used. One resident said I’m given a choice of three newspapers and there is always something or other going on. Other residents said they could choose not to be involved. Visitors said they were always made to feel welcome and kept up to date with everything. Some visitors visited in rooms and others were in communal areas. Residents were always offered a choice of meal. The lunchtime meal looked nutritious and appetising and was plentiful. Special diets were catered for and staff were seen giving support to those residents who needed extra help. Residents made positive comments about the food the meals are excellent and there is a choice you can have anything. A relative said that there was always a choice from the menu or the cooks would always find something that suits you. The chef met with residents and attended meetings to make sure residents were happy with the service. A meeting with residents was planned to discuss changes to the menu. The kitchen was clean and well organised. All kitchen staff were appropriately qualified. Records to show what meals had been served had not been maintained. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were protected by the homes policies, procedures and staff awareness. The home had a good complaints system and people were happy that their concerns would be listened to and responded to. EVIDENCE: A record of complaints was maintained. Residents and relatives knew whom to approach if they were unhappy. One relative said if things aren’t right they will do anything to make things right. The adult abuse procedures were clear and contained contact numbers for local agencies to ensure a prompt and appropriate response to any suspicion or allegation of abuse. Staff had received training to help them to protect the residents in their care. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The standard of the environment both inside and outside was generally safe, clean and comfortable although some areas could be improved. EVIDENCE: A tour of the home showed it was clean, generally odour free and tidy. The maintenance records showed that repairs were done promptly and the home was well maintained. Redecoration and refurbishment was an ongoing process to ensure that the home was bright, safe, comfortable and clean. Two residents confirmed that rooms were being re-decorated and new furnishings were provided in some rooms. Records showed that an audit of rooms was undertaken each month; however failed double glazing units and the stained corridor carpet had not been identified for attention. The home needed to ensure that all areas requiring
Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 16 attention are identified and action is taken to resolve the issue to ensure residents live in a safe and comfortable home. Resident’s rooms and communal areas were bright and comfortable. Some residents had brought in personal items to make their rooms more homely. Three residents said they were happy with their rooms. Only one resident had a key to her private accommodation. The registered manager said locks would be provided on request; there were no risk assessments to support nonprovision of keys to lockable storage space or private accommodation. All rooms had call units in place and staff answered any requests for attention promptly. Screening was in place in shared rooms. The outside of the home was well maintained and residents said they enjoyed the gardens. Garden furniture, flower tubs, bird tables, water features and chimes were provided for residents enjoyment. Aids and adaptations to assist staff to meet residents needs were seen around the home. The layout and design of the home was suitable for the people who lived there. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well staffed with a competent team of staff who were able to meet the needs of the residents. The home used thorough recruitment procedures to ensure residents were protected from unsuitable people. EVIDENCE: The staff rotas showed that the home provided staff in sufficient numbers and had staff with different skills and experience to ensure they were able to meet the diverse needs of the individuals living in the home. Residents and visitors said there were enough staff. There were a number of staff that had an appropriate qualification in care and others were working towards one. Records and discussion with staff showed that all staff were given relevant supervision, training and updates to help them to meet the needs of the residents in their care. Staff employment files were looked at and the records showed that a safe procedure had been followed and all checks were in place prior to new staff starting work. This made sure residents were protected from unsuitable people. One resident said ‘staff are grand’. A visitor said ‘everyone is looked after really well, the staff make sure of that’.
Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 18 Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was well managed and provided a safe place to live and work in. The home consulted regularly with residents and evidence showed that their views were both sought and acted upon. EVIDENCE: The registered manager is Jane Lyth, she is a qualified nurse and has an appropriate management qualification. Staff commented that they received support from management, were happy to raise areas of concern and said they would be listened to. Staff meetings were organised regularly for staff to voice their opinions. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 20 The home had a number of effective quality monitoring systems in place to make sure they were meeting people’s needs and expectations. Residents and relatives said they attended quality meetings where they were able to make changes and improvements about areas that affected them. The minutes showed the home had responded positively to issues raised. Residents surveys were completed annually; the results still needed to be published for residents, relatives and other interested parties. Policies and procedures had been reviewed. Clear accounting and financial records were maintained to protect resident’s financial interests. Any concerns regarding record keeping have been referred to under individual standards. Health and safety records had been properly maintained and systems protected residents, staff and visitors to the home. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement Timescale for action 09/10/06 2. OP9 13 3. 4. OP15 OP19 13 23 The registered person must ensure that the care plan details all aspects of the resident’s care needs and clearly identifies interventions to reduce or eliminate risks to residents. The registered person must 09/10/06 ensure that residents are allowed to take responsibility for their own medications if they wish, within a risk assessment framework and a procedure should be available to support this. The registered person must 09/10/06 maintain a detailed record of food provided for residents. The registered person must 09/10/06 ensure that all areas in the home that would benefit from repair/replacement and redecoration are clearly identified and prompt action taken to rectify the problem. Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP9 OP9 OP9 OP9 OP9 OP9 Good Practice Recommendations The registered person should ensure criteria for the administration of when required and variable dose medication is clearly defined and recorded. The registered person should ensure that all medicines have clear directions for administration and the use of ‘as directed’ is not used. The registered person should review all medication policies and procedures to prevent duplication. The registered person should make arrangements for safe storage of oxygen and use of appropriate signage. The registered person should ensure temperatures of medication storage areas are monitored regularly. The registered person should ensure there is written evidence to support care staff have had training and are competent to monitor blood glucose tests and that this is kept under review. The registered person should ensure residents are provided with keys to bedrooms and secure storage unless a risk assessment suggests otherwise. The registered person should complete an audit of failed double glazed units and take action to repair or replace the units. The registered person should ensure the first floor corridor carpet is either replaced or cleaned at more frequent intervals. 7. 8. 9 OP24 OP25 OP26 Walton House Nursing Home DS0000025584.V299521.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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